Chapter 27:Newborn nutrition and feeding

Question 1

1. A new mother recalls from prenatal class that she should try to feed her newborn whenever they exhibit hunger cues, rather than waiting until the infant is crying frantically. Which cue should the nurse alert this patient to regarding feeding their infant?
   a. The newborn is waving their arms in the air.
   b. The newborn is making sucking motions.
   c. The newborn is having hiccups.
   d. The newborn is stretching their legs out straight.

Answer 1

ANS: B
Sucking motions, rooting, mouthing, and hand-to-mouth motions are examples of feeding-readiness cues. Waving the arms in the air, hiccupping, and stretching the legs out straight are not typical hunger cues.

Question 2

2. A new father is ready to take his partner and newborn home. He proudly tells the nurse who is discharging them that, within the next week, he plans to start feeding the infant cereal between breastfeeding sessions. What does the nurse explain to him about beginning solid foods before 6 months?
   a. It may decrease the infant’s intake of sufficient calories.
   b. It may lead to decreased intake of breast milk.
   c. It may help the infant sleep through the night.
   d. It may limit the infant’s growth.

Answer 2

ANS: B
Introduction of solid foods before the infant is about 6 months of age may result in overfeeding and decreased intake of breast milk. It is not true that feeding of solids helps infants sleep through the night. The proper balance of carbohydrate, protein, and fat for an infant to grow properly is in the breast milk or formula.

Question 3

3. A postpartum patient telephones about her 6-day-old newborn. They are not scheduled for a newborn weight check until the infant is 10 days old, and they are worried about whether breastfeeding is going well. What will the nurse teach the patient that indicates effective breastfeeding?
   a. Newborn sleeps for 6 hours at a time between feedings.
   b. Newborn has at least one breast milk stool every 24 hours.
   c. Infant gains 30 to 60 grams per week.
   d. Infant has at least six wet diapers per day.

Answer 3

ANS: D
After day, when the mother’s milk comes in, the infant should have at least six sufficiently wet diapers every 24 hours, beginning after day 5. Sleeping for 6 hours between feedings is not an indication of whether the infant is breastfeeding well. Typically, infants sleep 2 to 4 hours between feedings, depending on whether they are being fed on a 2- to 3-hour schedule or cluster fed. The infant should have a minimum of three bowel movements in a 24-hour period. Breastfed infants typically gain 20 to 28 g/day.

Question 4

4. A primiparous patient wants to begin breastfeeding her newborn son as soon as possible. Which position best facilitates the infant’s correct latch-on?
   a. With his arms folded together over his chest
   b. Curled up in a fetal position
   c. With his head cupped in her hand
   d. With his head and body in alignment

Answer 4

ANS: D
The infant’s head and body should be in correct alignment with the mother and the breast during latch-on and feeding. Holding the infant with his arms folded together over his chest, curled up in a fetal position, or with his head cupped in her hand are not ideal positions to facilitate latch-on.

Question 5

5. A breastfeeding patient develops engorged breasts at 3 days postpartum. What action would help this patient achieve their goal of reducing the engorgement?
   a. Skip feedings to let their sore breasts rest.
   b. Avoid using a breast pump.
   c. Breastfeed their infant frequently.
   d. Reduce their fluid intake for 24 hours.

Answer 5

ANS: C
The mother should be instructed to attempt to feed the baby or pump frequently. Skipping feedings may cause further swelling and discomfort. If the infant does not feed adequately and empty the breast, the mother may pump to extract the milk and relieve some of the discomfort. Dehydration further irritates swollen breast tissue.

Question 6

6. At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 300 g in the past 4 weeks. Which will best assist the baby to gain weight faster?
   a. Begin solid foods.
   b. Have a bottle of formula after every feeding.
   c. Add at least one extra breastfeeding session every 24 hours.
   d. Add a supplement to the breastmilk to enhance the calorie consumption.

Answer 6

ANS: C
Usually the solution to slow weight gain is to improve the feeding technique. Position and latch-on are evaluated, and adjustments are made. It may help to add a feeding or two in a 24-hour period. Solid foods should not be introduced to an infant for at least 4 to 6 months. Bottle-feeding may cause nipple confusion and limit the supply of milk. Add extra calories to the breastmilk would not be appropriate at this time.

Question 7

7. A new mother wants to be sure that they are meeting their newborn’s needs while feeding them commercially prepared infant formula. The nurse should evaluate the mother’s knowledge about appropriate infant care. Which indicates that the mother is meeting her child’s needs?
   a. She adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition.
   b. She warms the bottles using a microwave oven.
   c. She burps her infant during and after the feeding as needed.
   d. She refrigerates any leftover formula for the next feeding.

Answer 7

ANS: C
Most infants swallow air when fed from a bottle and should be given a chance to burp several times during a feeding and after the feeding. Solid food should not be introduced to the infant for at least 6 months after birth. A microwave should never be used to warm any food to be given to an infant. The heat is not distributed evenly, which may pose a risk of burning the infant. Any formula left in the bottle after the feeding should be discarded because the infant’s saliva has mixed with it.

Question 8

8. The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. Which information from the mother would indicate that they need additional teaching?
   a. Breastmilk can be stored in the refrigerator for 3 months.
   b. Breastmilk can be frozen in the freezer for 3 months.
   c. Breastmilk can remain at room temperature for 8 hours.
   d. Breastmilk can be in the refrigerator for 3 to 5 days.

Answer 8

ANS: A
If the mother states that they can store their breastmilk in the refrigerator for 3 months, she needs additional teaching about safe storage. Breast milk can be stored at room temperature for 6 to 8 hours, in the refrigerator for 5 to 8 days, in the freezer for 3 to 6 months, or in a deep freezer for 12 months.

Question 9

9. Which is correct regarding recommendations about infant nutrition according to the Canadian Paediatric Society?
   a. Infants should be given only human milk for the first 6 months of life.
   b. Formula-fed infants should be started on solid food sooner than breastfed infants.
   c. If infants are weaned from breast milk before 12 months, they should receive
   cow’s milk, not formula.
   d. After 6 months mothers should shift from breast milk to cow’s milk.

Answer 9

ANS: A
The World Health Organization (WHO), Health Canada, Canadian Paediatric Society (CPS), and others recommend exclusive breastfeeding for the first 6 months of life for healthy, term infants with continued breastfeeding for 2 years or longer. If weaned before 12 months, infants should receive iron-fortified infant formula. Infants start on solids when they are ready, usually at 6 months, regardless of whether they start on formula or breast milk.

Question 10

10. According to demographic research, which patient would be least likely to breastfeed and thus most likely to need education on the benefits and proper techniques of breastfeeding?
    a. A patient who is 30 to 35 years of age, white, and employed part-time outside the
    home.
    b. A patient who is younger than 25 years of age, has small breasts, and
    unemployed.
    c. A patient who is in her early 30s and is obese.
    d. A patient who is 35 years of age or older, white, and employed full-time at home.

Answer 10

ANS: C
There appears to be a correlation between maternal weight and infant feeding decisions: patients who are overweight or obese are less likely to breastfeed than patients who are underweight or of average weight.

Question 11

11. Which is a late hunger cue in the newborn?
    a. Rooting
    b. Crying
    c. Tongue movements
    d. Hand to mouth movements

Answer 11

ANS: B
Crying is a late sign of hunger, and infants may become frantic when they have to wait too long to feed. Infants should be fed whenever they exhibit feeding cues such as hand-to-mouth movements, rooting, and mouth and tongue movements.

Question 12

12. What is the best reason for recommending formula over breastfeeding?
    a. The mother has active tuberculosis.
    b. The mother lacks confidence in her ability to breastfeed.
    c. Other family members or care providers also need to feed the baby.
    d. The mother sees bottle-feeding as more convenient.

Answer 12

ANS: A
Breastfeeding is contraindicated when the mother has active tuberculosis as well as in other situations. A lack of confidence, the need for others to feed the baby, and the convenience of bottle-feeding are all honest reasons for not breastfeeding, although further education concerning the ease of breastfeeding and its convenience, benefits, and adaptability (expressing milk into bottles) might change some minds. In any case, the nurse must provide information in a nonjudgemental manner and respect the mother’s decision.

Question 13

13. Which should nurses be aware of with regard to the nutrient needs of breastfed and formula-fed infants?
    a. Breastfed infants need extra water in hot climates.
    b. During the first 3 months breastfed infants consume more energy than
    formula-fed infants.
    c. Breastfeeding infants should receive oral vitamin D drops daily until their diet
    provides this or they are 1 year of age.
    d. Vitamin K injections at birth are not needed for infants fed on specially enriched
    formula.

Answer 13

ANS: C
Human milk contains only small amounts of vitamin D; therefore, breastfeeding infants should receive oral vitamin D drops daily until their diet provides this or they are 1 year of age. Neither breastfed nor formula-fed infants need to be given water, not even in very hot climates. During the first 3 months formula-fed infants consume more energy than breastfed infants and thus tend to grow more rapidly. Vitamin K shots are required for all infants because the bacteria that produce it are absent from the baby’s stomach at birth.

Question 14

14. Nurses providing nutritional instruction should be cognizant of the uniqueness of human milk. Which statement is correct?
    a. Frequent feedings during predictable growth spurts stimulate increased milk
    production.
    b. The milk of preterm mothers is the same as the milk of mothers who gave birth at
    term.
    c. The milk at the beginning of the feeding is the same as the milk at the end of the
    feeding.
    d. Colostrum is an early, less concentrated, less rich version of mature milk.

Answer 14

ANS: A
These growth spurts (10 days, 3 weeks, 6 weeks, 3 months, 6 months) usually last 24 to 48 hours, after which infants resume normal feeding. The milk of mothers of preterm infants is different from that of mothers of full-term infants, to meet the needs of these newborns. Milk changes composition during feeding. The fat content of the milk increases as the infant feeds. Colostrum precedes mature milk and is more concentrated and richer in proteins and minerals (but not fat).

Question 15

15. What should the nurse keep in mind when helping the breastfeeding mother position the baby for nursing?
    a. The cradle position usually is preferred by mothers who had a Caesarean birth.
    b. Patients with perineal pain and swelling prefer the modified cradle position.
    c. Whatever the position used, the infant’s body is to be in alignment.
    d. While supporting the head, the mother should push gently on the occiput.

Answer 15

ANS: C
The infant inevitably faces the mother with the baby’s body in alignment during latch and feeding. The football position usually is preferred after Caesarean birth. Patients with perineal pain and swelling prefer the side-lying position because they can rest while breastfeeding. The mother should never push on the back of the head. It may cause the baby to bite, hyperextend the neck, or develop an aversion to being brought near the breast.

Question 16

16. The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would be inaccurate and provide conflicting information to the patient?
    a. Patients who breastfeed have a decreased risk of breast cancer.
    b. Breastfeeding is not an effective method of birth control.
    c. Breastfeeding increases bone density.
    d. Breastfeeding may enhance after birth weight loss.

Answer 16

ANS: B
Patients who breastfeed have a decreased risk of breast cancer, an increase in bone density, and a possibility of quicker after birth weight loss. Breastfeeding delays the return of fertility and is an effective method of birth control for 6 months after birth (lactational amenorrhea method) as long as the infant is exclusive breastfeeding and the mother’s has not resumed menstruation.

Question 17

17. Which can result in the infant experiencing difficulty latching onto the breast?
    a. Breastfeeding babies receive supplementary bottle feedings.
    b. The baby is weaned too abruptly.
    c. Pacifiers are used before breastfeeding is established.
    d. Twins are breastfed together.

Answer 17

ANS: A
When babies go back and forth between bottles and breasts, especially before breastfeeding is established in 3 to 4 weeks, it may cause difficulty for the newborn to latch onto the breast, because the two require different skills. Abrupt weaning can be distressing to the mother, baby, or both but should not lead to nipple confusion. Pacifiers used before breastfeeding is established can be disruptive, but this does not lead to nipple confusion. Breastfeeding twins require some logistical adaptations, but this should not lead to nipple confusion.

Question 18

18. What should the nurse advise the breastfeeding patient with regard to basic care?
    a. They will need an extra 1000 calories a day to maintain energy and produce milk.
    b. They can go back to pre-pregnancy fluid consumption as long as they get enough
    calcium.
    c. They should avoid trying to lose large amounts of weight.
    d. They must avoid exercising because it is too fatiguing.

Answer 18

ANS: C
Large weight loss should be avoided because fat-soluble environmental contaminants to which they have been exposed are stored in the body’s fat reserves, and these may be released into the breastmilk. In addition, some mothers find that their milk supply decreases when caloric intake is severely restricted, as when eating too little or exercising too much. A breastfeeding mother need add only 330 extra calories to their diet to provide extra nutrients for the infant. The mother can go back to their consumption patterns of any drinks as long as she gets enough calcium, only if she does not drink alcohol, limits coffee to no more than two cups (caffeine in chocolate, tea, and some sodas), and reads the herbal tea ingredients carefully. The mother needs her rest, but moderate exercise is healthy.

Question 19

19. The breastfeeding mother should be taught a safe method to remove the breast from the baby’s mouth. Which suggestion by the nurse is most appropriate?
    a. Slowly remove the breast from the baby’s mouth when the infant has fallen asleep
    and the jaws are relaxed.
    b. Break the suction by inserting your finger into the corner of the infant’s mouth.
    c. A popping sound occurs when the breast is correctly removed from the infant’s
    mouth.
    d. Elicit the Moro reflex to wake the baby and remove the breast when the baby
    cries.

Answer 19

ANS: B
Inserting a finger into the corner of the baby’s mouth between the gums to break the suction avoids trauma to the breast. The infant who is sleeping may lose grasp on the nipple and areola, resulting in “chewing” on the nipple that makes it sore. A popping sound indicates improper removal of the breast from the baby’s mouth and may cause cracks or fissures in the breast. Most mothers prefer the infant to continue to sleep after the feeding. Gentle wake-up techniques are recommended.

Question 20

20. A mother who has just given birth and who intends to breastfeed tells their nurse, “I am so relieved that this pregnancy is over so I can start smoking again.” The nurse encourages the patient to refrain from smoking. However, this new mother insists that she will resume smoking. How should the nurse adapt her health teaching?
    a. Smoking has little or no effect on milk production.
    b. There is no relation between smoking and the time of feedings.
    c. The effects of secondhand smoke on infants are less significant than for adults.
    d. The mother should not smoke within 2 hours of breastfeeding.

Answer 20

ANS: D
The new mother should be encouraged not to smoke. Lactating mothers who continue to smoke should be advised not to smoke within 2 hours before breastfeeding. In addition, they along with other family members who smoke should go outside to smoke. Smoking may impair milk production. When the products of tobacco are broken down, they cross over into the breast milk. Tobacco also results in a reduction of the anti-infective properties of breast milk. The effects of secondhand smoke on infants include sudden infant death syndrome.

Question 21

21. Which statement concerning the benefits or limitations of breastfeeding is inaccurate?
    a. Breast milk changes over time to meet changing needs as infants grow.
    b. Long-term studies have shown that the benefits of breast milk continue after the
    infant is weaned.
    c. Breastfeeding may enhance cognitive development.
    d. Breastfeeding increases the risk of childhood obesity.

Answer 21

ANS: D
Breastfeeding actually decreases the risk of childhood obesity. There are multiple benefits of breastfeeding. Breast milk changes over time to meet changing needs as infants grow. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. Breastfeeding may enhance cognitive development.

Question 22

22. A pregnant patient wants to breastfeed her infant; however, her partner is not convinced that there are any scientific reasons to do so. The nurse can give the couple teaching comparing breastfeeding and bottle-feeding. Which statement is most accurate? Bottle-feeding using commercially prepared infant formulas
    a. increases the risk that the infant will develop allergies.
    b. helps the infant sleep through the night.
    c. ensures that the infant is getting iron in a form that is easily absorbed.
    d. requires that multivitamin supplements be given to the infant.

Answer 22

ANS: A
Exposure to cow’s milk poses a risk of developing allergies, eczema, and asthma. “Bottle-feeding using commercially prepared infant formulas helps the infant sleep through the night” is a false statement. Iron is better absorbed from breast milk than from formula. Commercial formulas are designed to meet the nutritional needs of the infant and resemble breast milk.

Question 23

23. Which type of formula is not diluted before being administered to a newborn?
    a. Powdered
    b. Concentrated
    c. Ready-to-use
    d. Modified cow’s milk

Answer 23

ANS: C
Ready-to-use formula can be poured directly from the can into baby’s bottle and is good (but expensive) when a proper water supply is not available. Formula should be well mixed to dissolve the powder and make it uniform in consistency. Improper dilution of concentrated formula may cause malnutrition or sodium imbalances. Cow’s milk is more difficult for the infant to digest and is not recommended, even if it is diluted.

Question 24

24. How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day
    a.50 to 60
    b.75 to 90
    c. 85 to 100
    d. 150 to 200

Answer 24

ANS: C
The term newborn needs 85 to 100 kcal/kg/day.

Question 25

25. What is the hormone necessary for milk production?
    a. Estrogen
    b. Prolactin
    c. Progesterone
    d. Lactogen

Answer 25

ANS: B
Prolactin, secreted by the anterior pituitary, is a hormone that causes the breasts to produce milk. Estrogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Progesterone decreases the effectiveness of prolactin and prevents mature breast milk from being produced. Human placental lactogen decreases the effectiveness of prolactin and prevents mature breast milk from being produced.

Question 26

26. To initiate the milk ejection reflex (MER), the mother should be advised to
    a. wear a firm-fitting bra.
    b. drink plenty of fluids.
    c. place the infant to the breast.
    d. apply cool packs to her breast.

Answer 26

ANS: C
Oxytocin, which causes the MER reflex, increases in response to nipple stimulation. A firm bra is important to support the breast; however, will not initiate the MER reflex. Drinking plenty of fluids is necessary for adequate milk production, but this alone will not initiate the MER reflex. Cool packs to the breast will decrease the MER reflex.

Question 27

27. As the nurse assists a new mother with breastfeeding, the patient asks, “If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better?” The nurse’s best response is that it contains
    a. more calories.
    b. essential amino acids.
    c. important immunoglobulins.
    d. more calcium.

Answer 27

ANS: C
Breast milk contains immunoglobulins that protect the newborn against infection. The calorie count of formula and breast milk is about the same. All the essential amino acids are in both formula and breast milk; however, the concentrations may differ. Calcium levels are higher in formula than in breast milk. This higher level can cause an excessively high renal solute load if the formula is not diluted properly.

Question 28

28. When responding to the question “Will I produce enough milk for my baby as they grow and needs more milk at each feeding?” the nurse should explain that
    a. the breast milk will gradually become richer to supply additional calories.
    b. as the infant requires more milk, feedings can be supplemented with cow’s milk.
    c. early addition of baby food will meet the infant’s needs.
    d. the mother’s milk supply will increase as the infant demands more at each
    feeding.

Answer 28

ANS: D
The amount of milk produced depends on the amount of stimulation of the breast. Increased demand with more frequent and longer breastfeeding sessions results in more milk available for the infant. Mature breast milk will stay the same. The amounts will increase as the infant feeds for longer times. Supplementation will decrease the amount of stimulation of the breast and decrease the milk production. Solids should not be added until about 4 to 6 months, when the infant’s immune system is more mature. This will decrease the chance of allergy formations.

Question 29

29. To prevent nipple trauma, the nurse should instruct the new mother to
    a. limit the feeding time to less than 5 minutes.
    b. position the infant so the nipple is far back in the mouth.
    c. assess the nipples before each feeding.
    d. wash the nipples daily with mild soap and water.

Answer 29

ANS: B
If the infant’s mouth does not cover as much of the areola as possible, the pressure during sucking will be applied to the nipple, thus causing trauma to the area. Stimulating the breast for less than 5 minutes will not produce the extra milk the infant may need. This will also limit access to the higher-fat “hindmilk.” Assessing the nipples for trauma is important; however, this action alone will not prevent sore nipples. Soap can be drying to the nipples and should be avoided during breastfeeding.

Question 30

30. Parents have been asked by the neonatologist to provide breastmilk for their newborn, who was born prematurely at 32 weeks of gestation. The nurse who instructs them about pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement by the parents is correct?
    a. A premature infant more easily digests breast milk than formula.
    b. A glass of wine just before pumping will help reduce stress and anxiety.
    c. The mother should pump only as much as the infant can drink.
    d. The mother should pump every 2 to 3 hours, including during the nigh

Answer 30

ANS: A
Human milk is the ideal food for preterm infants, with benefits that are unique in addition to those received by term, healthy newborns. Greater physiological stability occurs with breastfeeding compared with formula feeding. Consumption of alcohol during lactation is approached with caution. Excessive amounts can have serious effects on the infant and can adversely affect the mother’s milk ejection reflex. To establish an optimal milk supply, the mother should be instructed to pump 8 to 10 times a day for 10 to 15 minutes on each breast.

Question 31

31. A new mother asks whether they should feed their newborn colostrum, because it is not “real milk.” The nurse’s most appropriate answer is
    a. colostrum is high in antibodies, protein, vitamins, and minerals.
    b. colostrum is lower in calories than milk and should be supplemented by formula.
    c. giving colostrum is important in helping the mother learn how to breastfeed
    before she goes home.
    d. colostrum is unnecessary for newborns.

Answer 31

ANS: A
Colostrum is important because it has high levels of the nutrients needed by the newborn and helps protect against infection. Supplementation is not necessary; it will decrease stimulation to the breast and decrease the production of milk. It is important for the mother to feel comfortable in this role before discharge; however, the importance of the colostrum to the infant is the top priority. Colostrum provides immunities and enzymes necessary to cleanse the gastrointestinal system, among other things.

Question 32

32. Which nutrient’s recommended dietary allowance (RDA) is higher during lactation than during pregnancy?
    a. Iodine
    b. Iron
    c. Vitamin A
    d. Folic acid

Answer 32

ANS: A
Needs for energy (kilocalories), protein, calcium, iodine, zinc, the B vitamins (thiamine, riboflavin, niacin, pyridoxine, and vitamin B12), and vitamin C are greater during lactation than during pregnancy. Iron recommendation is lower during lactation than in pregnancy. Folic acid recommendation is lower during lactation than in pregnancy. Vitamin A recommendation is lower during lactation than in pregnancy.

Question 33

33. Which should a nurse be aware of with regard to nutritional needs during lactation?
    a. The mother’s intake of vitamin C, zinc, and protein now can be lower than during
    pregnancy.
    b. Caffeine consumed by the mother accumulates in the infant, who therefore may
    be unusually active and wakeful.
    c. Critical iron and folic acid levels must be maintained.
    d. Lactating women can go back to their pre-pregnant calorie intake.

Answer 33

ANS: B
A lactating woman needs to avoid consuming too much caffeine. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume 330 kcal more than their pre-pregnancy intake, at least 1800 kcal daily overall.

Question 34

1. Which should the nurse teach the new mother about bottle-feeding using commercially prepared infant formulas? (Select all that apply.)
   a. In the first day or two of life a newborn typically consumes 10 to 30 mL of formula per feeding.
   b. Using formula helps the infant sleep through the night.
   c. Using formula ensures that the infant is getting iron in a form that is easily
   absorbed.
   d. Using formula requires that multivitamin supplements be given to the infant.
   e. Bottles should never be propped with a pillow when feeding an infant.
   f. A slow-flow nipples is often used for the first few weeks.

Answer 34

ANS: A, E, F
In the first day or two of life a newborn typically consumes 10 to 30 mL of formula per feeding. Bottles should never be propped with a pillow of other inanimate object and left with the infant. The typical fast flow of milk from bottles can create difficulty for an infant trying to learn to feed. A slow-flow nipple is often used for the first few weeks. Multivitamin supplements are not needed with commercial formulas.

Question 35

2. Which statements about the benefits or limitations of breastfeeding are accurate? (Select all that apply.)
   a. Breast milk changes over time to meet changing needs as infants grow.
   b. Long-term studies have shown that the benefits of breast milk continue after the
   infant is weaned.
   c. Breast milk and breastfeeding may enhance cognitive development.
   d. Breastfeeding increases the risk of childhood obesity.
   e. Newborns should be exclusively breastfed for the first year of life.
   f. The major immunoglobulin in human milk is IgG.

Answer 35

ANS: A, B, C
Breastfeeding actually decreases the risk of childhood obesity. There are multiple benefits of breastfeeding. Breast milk changes over time to meet changing needs as infants grow. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. Breast milk and breastfeeding may enhance cognitive development. Newborns should be exclusively breastfed for the first 6 months of life. The major immunoglobulin in human milk is IgA.

Question 36

3. Which are correct regarding the benefits to the mother associated with breastfeeding? (Select all that apply.)
   a. People who breastfeed have a decreased risk of breast cancer.
   b. It is an effective method of birth control for the first year after birth.
   c. It increases bone density.
   d. It may enhance postpartum weight loss.
   e. It is associated with an increased risk of postpartum hemorrhage.
   f. They have an increased risk of ovarian cancer.

Answer 36

ANS: A, C, D
Patients who breastfeed have a decreased risk of breast cancer, an increase in bone density, and a possibility of quicker postpartum weight loss. The lactational amenorrhea method of birth control can be a highly effective temporary method of birth control for the first 6 months, not 1 year, if the patient is exclusively breastfeeding. It is associated with a decreased risk of postpartum hemorrhage.

Question 37

4. Which signs would the nurse teach the breastfeeding mother that indicate the infant has latched on correctly to her breast? (Select all that apply.)
   a. The mother feels a firm tugging sensation on their nipples.
   b. The baby sucks with cheeks rounded, not dimpled.
   c. The baby’s jaw glides smoothly with sucking.
   d. The mother hears a clicking or smacking sound.
   e. The baby’s nose is depressing the breast.
   f. The mother feels a pinching on their nipple throughout the entire feeding.

Answer 37

ANS: A, B, C
The clicking or smacking sound may indicate that the baby is having difficulty keeping the tongue out over the lower gum ridge. The mother should hope to hear the sound of swallowing. The tugging sensation without pinching is a good sign; with pinching it is a sign of a poor latch. Rounded cheeks are a good sign. A smoothly gliding jaw is a good sign. The baby’s chin should be pressed into the breast, and the cheeks and nose may be lightly touching the breast but not depressing the breast, as the baby is a nose breather.

Question 38

5. Examples of appropriate techniques to teach parents to wake a sleepy infant for breastfeeding include (Select all that apply.)
   a. unwrapping the infant.
   b. changing the diaper.
   c. talking to the infant.
   d. slapping the infant’s hands and feet.
   e. applying a cold towel to the infant’s abdomen.

Answer 38

NS: A, B, C
Unwrapping the infant, changing the diaper, and talking to the infant are appropriate techniques to use when trying to wake a sleepy infant. Slapping the infant’s hand and feet and applying a cold towel to the infant’s abdomen are not appropriate. The parent can rub the infant’s hands or feet to wake the infant. Applying a cold towel to the infant’s abdomen may lead to cold stress in the infant. The parent may want to apply a cool cloth to the infant’s face to wake the infant.

Question 39

6. A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. What signs and symptoms should the nurse include in her discussion? (Select all that apply.)
   a. Breast tenderness
   b. Warmth in the breast
   c. An area of redness on the breast often resembling the shape of a pie wedge
   d. A small white blister on the tip of the nipple
   e. Fever and flu-like symptoms

Answer 39

ANS: A, B, C, E
Breast tenderness, breast warmth, breast redness, and fever and flu-like symptoms are commonly associated with mastitis and should be included in the nurse’s discussion of mastitis. A small white blister on the tip of the nipple generally is not associated with mastitis. It is commonly seen in patients who have a plugged milk duct.

Question 40

7. Late in pregnancy, the patient’s breasts should be assessed by the nurse to identify any potential concerns related to breastfeeding. Some nipple conditions make it necessary to provide intervention before birth. These include (Select all that apply.)
   a. everted nipples.
   b. flat nipples.
   c. inverted nipples.
   d. nipples that contract when compressed.
   e. cracked nipples.

Answer 40

ANS: B, C, D
Flat nipples appear soft, like the areola, and do not stand erect unless stimulated by rolling them between the fingers. Inverted nipples are retracted into the breast tissue. These nipples appear normal; however, they will draw inward when the areola is compressed by the infant’s mouth. Dome-shaped devices known as breast shells can be worn during the last weeks of pregnancy and between feedings after birth. The shells are placed inside the bra with the opening over the nipple. The shells exert slight pressure against the areola to help the nipples protrude. The helpfulness of breast shells is debated. A breast pump can be used to draw the nipples out before feedings after delivery. Everted nipples protrude and are normal. No intervention will be required. Cracked, blistered, and bleeding nipples occur after breastfeeding has been initiated and are the result of improper latch. The infant should be repositioned during feeding. Application of colostrum and breast milk after feedings will aid in healing.